Schools and Long-term Care Settings

The Hawaii Department of Health requires all institutions experiencing a suspected influenza outbreak to report this information immediately.

Information regarding how to define a “suspected influenza outbreak” is provided below.

What are the symptoms of flu?
Flu has an incubation period of 1-4 days, with an average of about 2 days.

Symptoms usually develop quickly and include:

• Fever (usually high)
• Headaches
• Sore throat
• Dry cough
• Runny or stuffy nose
• Muscle aches
• Extreme tiredness
• Gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, are much more common among children than adults.

The flu can range in severity of illness from person to person. If some people, the illness will be mild, while in other special populations, the illness can range in severity, and sometimes lead to serious complications.

Schools

When are we required to report flu like activity to Hawaii Department of Health?

Schools are required to report flu like activity to the Hawaii Department of Health when absentee rate exceeds 10% for entire school OR absentee rate exceeds 20% of one grade or class. An influenza-like illness* outbreak is confirmed when at least one student has a positive PCR or culture test for influenza.

*Influenza-like illness (ILI) is defined as a cough/sore throat and fever (>100° F) or chills.

How should I go about reporting flu-like-activity to the Hawaii Department of Health?

In order to report influenza like activity to HDOH, please download and fill out the following form to the best of your ability.

School Influenza-like Illness Activity Form (Word Document)

School ILI Line List (Excel File)

I am not sure if the influenza-like-activity in my school needs to be reported.

Please contact the Department of Health’s Disease Investigation Branch if you have any questions. Find contact information for your island here. ILI activity in schools is immediately reportable, so please do not hesitate to call.
DOH personnel will assist you in determining how to proceed with your particular situation.

During an outbreak, how will the Hawaii Department of Health assist me?

Reporting information to HDOH is not a one-way street. By the time you call us, many children in your school may be out sick. Your health room may be flooded with children showing flu-like-symptoms. HDOH is here to help you get past this flu-like-illness activity in your school.

When you contact HDOH, we will send you free kits to swab your students. You may be able to work closely with your public health nurse or Disease Investigation Branch personnel to collect specimens for testing at the Hawaii State Laboratories Division.

Once the specimens have been tested, we will know if your school has an influenza outbreak. In the event of an influenza outbreak, DOH personnel will provide you with materials you may need to encourage students to stay at home and practice good hygiene.

Instructions for Maintaining the Specimen Collection Kits and for Swabbing

1. Tubes of VTM (viral transport medium) should be kept refrigerated at all times.
2. VTM is relatively stable. Tubes provided can be used throughout the influenza season provided the date of usage does not exceed the expiration date printed on the outside of the tube.
3. Collect throat swabs only on individuals who became ill within the last 72 hours AND meet the following influenza-like illness criteria:
   1. Fever > 100ºF, AND
   2. Cough, sore throat, or other respiratory symptoms.
4. Throat swab procedure:
   1. Remove both swabs from the wrapper.
   2. Moisten both swabs with VTM by dipping into the tube.
   3. Vigorously swab the posterior pharynx and tonsil area (avoiding tongue)
   4. Return the swabs to the same tube of VTM.
   5. Break off sticks so that screw cap can be securely replaced.
   6. Refrigerate tube immediately.
   7. Complete the laboratory form provided

Download printable instructions for throat swab (PDF)

Long Term Care Facilities

When are we required to report flu like activity?

Long Term Care Facilities are required to report flu like activity to the Hawaii Department of Health when three (3) or more cases of ILI are detected on a single unit during a period of 48 to 72 hours. A unit is defined as anyway that the facility divides their building, be it rooms, floors, or wards.
An ILI outbreak is confirmed when at least one resident has a positive culture or rapid-antigen test for influenza.

*Influenza-like illness (ILI) is defined as a cough/sore throat and fever (>100° F) or chills.

How should I go about reporting flu-like-activity to the Hawaii Department of Health?

In order to report influenza like activity to HDOH, please download and fill out the following form to the best of your ability.

Long-term Care Influenza-like Illness Activity Form (Word Document)

Long-term Care Line List

Once the form is filled out, please fax it to the Department of Health’s Disease Investigation Branch at (808) 586-4595.

I am not sure if the influenza-like-activity in my long term care facility needs to be reported.

Please contact the Department of Health’s Disease Investigation Branch if you have any questions. Find contact information for your island here. ILI activity in nursing homes and long term care facilities is immediately reportable, so please do not hesitate to call. DOH personnel will assist you in determining how to proceed with your particular situation.